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Open Access Highly Accessed Research article

Recommendations for and compliance with social restrictions during implementation of school closures in the early phase of the influenza A (H1N1) 2009 outbreak in Melbourne, Australia

Jodie McVernon1*, Kate Mason2, Sylvia Petrony2, Paula Nathan12, Anthony D LaMontagne3, Rebecca Bentley2, James Fielding457, David M Studdert68 and Anne Kavanagh2

Author Affiliations

1 Vaccine & Immunisation Research Group, Murdoch Children's Research Institute and Melbourne School of Population Health, University of Melbourne, Australia

2 Centre for Women's Health, Gender and Society, Melbourne School of Population Health, University of Melbourne, Australia

3 McCaughey Centre, Melbourne School of Population Health, University of Melbourne, Australia

4 Victorian Infectious Diseases Reference Laboratory, North Melbourne, Australia

5 Victorian Government Department of Health, Melbourne, Australia

6 Centre for Health Policy, Programs and Economics, Melbourne School of Population Health, University of Melbourne, Australia

7 National Centre for Epidemiology & Population Health, The Australian National University, Canberra, Australia

8 Melbourne Law School, University of Melbourne, Australia

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BMC Infectious Diseases 2011, 11:257  doi:10.1186/1471-2334-11-257

Published: 30 September 2011

Abstract

Background

Localized reactive school and classroom closures were implemented as part of a suite of pandemic containment measures during the initial response to influenza A (H1N1) 2009 in Melbourne, Australia. Infected individuals, and those who had been in close contact with a case, were asked to stay in voluntary home quarantine and refrain from contact with visitors for seven days from the date of symptom onset or exposure to an infected person. Oseltamivir (Tamiflu®) was available for treatment or prophylaxis.

Methods

We surveyed affected families through schools involved in the closures. Analyses of responses were descriptive. We characterized recommendations made to case and contact households and quantified adherence to guidelines and antiviral therapy.

Results

Of the 314 respondent households, 51 contained a confirmed case. The prescribed quarantine period ranged from 1-14 days, reflecting logistic difficulties in reactive implementation relative to the stated guidelines. Household-level compliance with the requirement to stay at home was high (84.5%, 95% CI 79.3,88.5) and contact with children outside the immediate family infrequent.

Conclusions

Levels of compliance with recommendations in our sample were high compared with other studies, likely due to heightened public awareness of a newly introduced virus of uncertain severity. The variability of reported recommendations highlighted the difficulties inherent in implementing a targeted reactive strategy, such as that employed in Melbourne, on a large scale during a public health emergency. This study emphasizes the need to understand how public health measures are implemented when seeking to evaluate their effectiveness.